Just Another Teachin’ Tuesday: The Baby Blues & Postpartum Depression

Bill WhiteJune 21, 2010

Everyone’s heard of the baby blues. Okay, so I’m a guy; but I can still write about these things. Well, word’s on the streets that a severe case of the baby blues may well be a prodromal (something’s just about to happen) stage for postpartum depression.

This piece is based in the fascinating work of Julia Sacher, of the Max Planck Institute For Human Cognitive and Brain Sciences, Leipzig, and Jeffrey H. Meyer, of the Centre For Addiction and Mental Health, Toronto. The scoop was published in the May 26, 2010 edition of Archives of General Psychiatry.

Before we get into the study, let’s do a quick postpartum depression/baby blues FYI…

Simply, postpartum depression is diagnosed upon the occurrence of a major depressive episode within 4 weeks of delivery. Prevalence in the United States is estimated at 13% of new mothers.

Underscored by an interruption in overall functioning, as well as caring for self and baby, typical symptoms include – loss of appetite, insomnia, irritability/anger, intense fatigue, loss of interest in pleasurable activities, feelings of shame and guilt, mood swings, bonding issues with baby, social isolation, thoughts of harm to self or baby. And, of course, these symptoms are consistent with those of a major depressive episode.

Now, the baby blues is much more prevalent, and the symptoms not as severe – anxiety, irritability, crying, trouble sleeping, feeling sad, mild to moderate mood swings.

Well, just one more interesting piece of table-setting information…

Enter monoamine oxidase A (MAO-A). Maybe “monoamine” is ringing a bell. Well, that could be because the monoamines are a group of neurotransmitters and neuromodulators, which include serotonin, norepinephrine, epinephrine, and dopamine. The hormone, melatonin, is also a monoamine. Perhaps you take a monoamine oxidase inhibitor (MAOI), like tranylcypromine (Parnate) or the selegiline transdermal patch (Emsam).

MAO-A, an enzyme, works to catalyze the oxidation of monoamines, which in essence breaks them down. And it’s found in neurons and specific types of glial cells in the brain and spinal cord. It’s also found in the liver, gastrointestinal tract, and placenta.

Back to the study. It’s known that estrogen levels drop 100-1000 times in the first three to four days after giving birth. As it turns out, levels of MAO-A proportionally increase big-time. Using PET scans, the research team discovered levels of MAO-A were an average of 43% higher in women who’d just given birth, compared to a control group.

And levels of MAO-A were at their highest five days after birth – which just happens to coincide with the time new mothers traditionally hit the very depths of the baby blues.

Okay, so the study suggests the baby blues very often sets the stage for the presentation of postpartum depression. And if that’s the case, the aggressive treatment of the baby blues, as soon as it presents, makes perfect sense.

This can be accomplished using medicinal interventions in an effort to lower levels of MAO-A or to increase concentrations of pertinent monoamines – particularly serotonin and norepinephrine. So it’s all about maintaining a sense of balance.

But then up pops the issue of breastfeeding, and its incompatibility with certain medications. Fascinatingly, the research team proposes the introduction of dietary supplements of what are known as monoamine precursors – the very building blocks of serotonin, norepinephrine – even dopamine. These would include the amino acids, tryptophan and tyrosine.

And there it is for Another Teachin’ Tuesday – June 22, 2010. The relationship between the baby blues, monoamine oxidase A (MAO-A), and postpartum depression – I sure as heck learned something.